National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 57 Research Studies DisplayedMelton K, Liu J, Sadeghi H
Predictors of transition outcomes in cystic fibrosis: analysis of National Patient Registry and CF RISE (Responsibility. Independence. Self-care. Education) data.
This retrospective cohort study’s goal was to identify predictors of transition outcomes in cystic fibrosis (CF) patients aged 16-25 years who transitioned to adult care from 2013 to 2019. The authors used data from the CF Foundation Patient Registry and the web-based transition program CF RISE (Responsibility. Independence. Self-care. Education). They modeled change in forced expiratory volume in 1 second % predicted and weight using linear regression fit with generalized estimating equations. Predictor variables included gap in care (time between last pediatric and first adult outpatient visit), transition program engagement, and sociodemographic and medical factors. Among 12,420 adolescents and young adults, 3876 transitioned to adult care with a median gap in care of 7.6 months. Patients from CF centers that have greater rates of CF RISE engagement had improved lung function and weight at their first adult outpatient visit. Patients with coverage on a parent's insurance plan and absence of CF complications predicted increased lung function. Sinus disease and history of a nonlung transplant predicted increased weight. Comorbid diabetes mellitus and gaps in care greater than 3 months predicted decreased lung function with longer gaps in care associated with greater decrease. Care gaps of 6 to 9 months predicted decreased weight. Other control variables including baseline forced expiratory volume in 1 second and weight, and exacerbation status were also statistically significant.
AHRQ-funded; HS000063.
Citation: Melton K, Liu J, Sadeghi H .
Predictors of transition outcomes in cystic fibrosis: analysis of National Patient Registry and CF RISE (Responsibility. Independence. Self-care. Education) data.
J Pediatr 2024 Feb; 265:113812. doi: 10.1016/j.jpeds.2023.113812.
Keywords: Chronic Conditions, Respiratory Conditions, Children/Adolescents, Transitions of Care
Waltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S .
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Silverstein GD, Styke SC, Kaur S
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
This study’s objective was to evaluate the associations between health/eHealth literacy and depressive symptoms with app usage and clinical outcomes. The authors recruited adults with persistent asthma to utilize the ASTHMAXcel PRO mobile app. Participants completed the following questionnaires: Patient Health Questionnaire-9 (PHQ-9) to assess for depressive symptoms, Asthma Control Test (ACT), Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign (NVS) tool to measure health literacy. Subsets of participant data were available on eHealth literacy (eHeals) (n = 24) and average number of app logins across 2 months (n = 40). The average participant age was 44.0 years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control and asthma QOL, but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL and more app logins. NVS scores weren’t associated with any measures.
AHRQ-funded; HS025645.
Citation: Silverstein GD, Styke SC, Kaur S .
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
Psychosom Med 2023 Sep 1; 85(7):605-11. doi: 10.1097/psy.0000000000001170..
Keywords: Health Literacy, Asthma, Telehealth, Health Information Technology (HIT), Education: Patient and Caregiver, Outcomes, Respiratory Conditions, Chronic Conditions
Dunbar PJ, Sobotka SA, Rodean J
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
The impact of ear, nose, throat, and respiratory infections (ENTRIs) on children with complex chronic conditions (CCCs) may vary from that of their counterparts. The purpose of this study was to examine the prevalence and expenditure of ENTRIs in children with and without CCCs. A retrospective evaluation of 3,880,456 children aged 0-18 years enrolled in 9 US state Medicaid programs in 2018, as recorded in the IBM Watson Marketscan Database, was conducted. Feudtner's classification system was employed to identify the type and quantity of CCCs. The prevalence of ENTRIs, defined as one or more healthcare visits for ENTRIs, and Medicaid expenditure on ENTRIs were compared based on CCC status using chi-square tests and logistic regression. The study found that ENTRIs were more prevalent in children with CCCs than in those without. Children with a CCC represented approximately one-fourth ($145.8 million [US]) of the total ENTRI expenditure. Excluding throat and sinus infections, the prevalence of ENTRIs rose with the number of CCCs. For instance, the prevalence of lower-airway infections increased from 12.5% to 37.5% as the number of CCCs grew from zero to ≥3. Inpatient care-associated ENTRI expenditure rose from 9.7% to 92.8% as the number of CCCs increased from zero to ≥3.
AHRQ-funded; HS025138
Citation: Dunbar PJ, Sobotka SA, Rodean J .
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
Acad Pediatr 2023 Mar;23(2):434-40. doi: 10.1016/j.acap.2022.07.004.
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Healthcare Costs
Duan KI, Birger M, Au DH
Health care spending on respiratory diseases in the United States, 1996-2016.
The objectives of this study were to estimate health care spending in the U.S. for 11 respiratory conditions from 1996 to 2016, and to provide an evaluation of factors associated with spending growth and detailed trends. Data was taken from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database. The results showed that spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. The authors concluded that these findings suggest that service price and intensity should be a key focus for policymakers who seek to reduce health care spending growth.
AHRQ-funded; HS026369.
Citation: Duan KI, Birger M, Au DH .
Health care spending on respiratory diseases in the United States, 1996-2016.
Am J Respir Crit Care Med 2023 Jan 15; 207(2):183-92. doi: 10.1164/rccm.202202-0294OC..
Keywords: Respiratory Conditions, Healthcare Costs, Asthma, Chronic Conditions
Rojas JC, Chokkara S, Zhu M
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
The purpose of this study was to assess changes in the quality of care for patients hospitalized for Chronic obstructive pulmonary disease (COPD) after the implementation of the Hospital Readmissions Reduction Program (HRRP) which levied financial penalties on hospitals for excessive COPD readmissions. The researchers reviewed the records from 995 U.S. hospitals in the Premier Healthcare Database, evaluating patients older than 40 years of age hospitalized for COPD. The study included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions, and found that recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP. Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP. The researchers concluded that after HRRP implementation, the pre-HRRP trends toward improving care quality for inpatient COPD care slowed.
AHRQ-funded; HS027804.
Citation: Rojas JC, Chokkara S, Zhu M .
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
Am J Respir Crit Care Med 2023 Jan; 207(1):29-37. doi: 10.1164/rccm.202203-0496OC..
Keywords: Respiratory Conditions, Quality of Care, Hospital Readmissions, Chronic Conditions
Snyder BM, Patterson MF, Gebretsadik T
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. With data from the Tennessee Medicaid Program, findings showed that women with asthma had an increased risk of filling at least one prenatal antibiotic prescription and had an increased number of fills during pregnancy compared to women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy.
AHRQ-funded; HS018454.
Citation: Snyder BM, Patterson MF, Gebretsadik T .
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
J Asthma 2022 Oct;59(10):2100-07. doi: 10.1080/02770903.2021.1993247..
Keywords: Asthma, Respiratory Conditions, Pregnancy, Antibiotics, Antimicrobial Stewardship, Medication, Maternal Care, Women, Chronic Conditions
Kim B, Mulready-Ward C, Thorpe LE
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
This study assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing, and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). The authors used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma (“ever asthma”) and experiencing an asthma attack within the past year. They also examined whether associations were modified by smoking status (among adults), smoking within the house (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma and past-year asthma attack. Rental assistance housing living was also significantly associated with ever asthma. Public or rental assistance housing associations and ever asthma were marginally significant among children but were more pronounced among ever smokers than among never smokers.
AHRQ-funded; HS026120.
Citation: Kim B, Mulready-Ward C, Thorpe LE .
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
Prev Med 2022 Aug;161:107147. doi: 10.1016/j.ypmed.2022.107147..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Vulnerable Populations, Urban Health, Chronic Conditions
Fisher KA, Kennedy K, Bloomstone S
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
The purpose of this study was to explore the effect of physicians sharing their clinical notes with patients with chronic obstructive pulmonary disease (COPD) and assess the impact on patient-physician communication and patient self-management. The researchers conducted interviews with 30 patients with COPD, asking them to review their clinic notes. The participants were primarily White (93.3%) with an average age of 65.5 years; more than 50% reported having a high school degree or less, almost half reported sometimes requiring help to read medical materials, and half had challenges understanding spoken information. The study found that patients reported that having the clinic notes gave them an opportunity to learn more about their condition, and encouraged their self-management by reminding them of their action steps, serving as prompts for seeking information, and motivating them. Patients indicated positive reactions to those physician notes that implied their clinician considered them as a person, listened to them, and noticed details about them. The majority of patients reported negative reactions to incorrect information in the notes, wording that they considered disapproving, and medical terms. The study concluded that the act of providers sharing their clinical notes with their patients can serve multiple purposes, including encouraging the exchange of information and self-management, and improving the relationship between patients and providers.
AHRQ-funded; HS024596.
Citation: Fisher KA, Kennedy K, Bloomstone S .
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
Patient Educ Couns 2022 Mar;105(3):726-33. doi: 10.1016/j.pec.2021.06.004..
Keywords: Respiratory Conditions, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Self-Management
Jaladanki S, Schechter SB, Genies MC
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
This study’s objective was to identify strategies associated with sustained guideline adherence and high-quality pediatric asthma care in community hospitals. Hospitals who were part of the Pathways for Improving Pediatric Asthma Care (PIPA) national quality improvement (QI) intervention were included. Clinicians (n = 19) involved in clinical care of children hospitalized with asthma were interviewed from five higher- and three lower-performing hospitals. Higher-performing hospitals had dedicated local champions who consistently provided reminders of evidence-based practices and delivered ongoing education. These champions also modified/developed electronic health record (EHR) tools. Lower-performing hospital clinicians described unique barriers, including delays in modifying the EHR and lack of automation of EHR tools. For all hospitals, barriers to sustainability included challenges with quality monitoring, decreasing focus of local champions over time, and ongoing difficulties developing around evidence-based practices.
AHRQ-funded; HS027041.
Citation: Jaladanki S, Schechter SB, Genies MC .
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
Health Serv Res 2022 Feb;57(1):125-36. doi: 10.1111/1475-6773.13870..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Hospitals, Quality of Care
Ong T, Onchiri FM, Britto MT
Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis.
This study’s purpose was to characterize nutrition management for infants with cystic fibrosis (CF) with inadequate weight gain and to assess association of dietitian assessments and center-level weight-for-age Z-scores (WAZ). Encounter data from 226 infants was used from across 28 US CF Centers from the Baby Observational Nutritional study between January 2012 through December 2017. The authors identified dietitian assessments and consensus guideline-recommended responses to inadequate weight gain: calorie increases, pancreatic enzyme replacement therapy (PERT) increases, or shortened time to next visit. They compared center assessments by funnel plot and summarized median WAZ by center. Of 2,527 visits, 808 visits had identified inadequate weight gain, distributed in 216 infants. Assessments occurred in 77% of visits but varied widely between centers (range 17% - 98%). They used funnel plot analysis to identify high-performers for frequent dietitian assessments (range 92% - 98%) and 4 under-performers (range 17% - 56%). High-performers treated inadequate weight gain more often with adequate calories (80% vs 52%) and closer follow-up (63% vs 49%) compared to underperformers. Three of 4 high-performing sites met center nutrition goals for positive median WAZ at 2 years old unlike 3 under-performers, despite similar patient characteristics.
AHRQ-funded; HS026393.
Citation: Ong T, Onchiri FM, Britto MT .
Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis.
J Cyst Fibros 2022 Jan; 21(1):115-22. doi: 10.1016/j.jcf.2021.08.005..
Keywords: Newborns/Infants, Respiratory Conditions, Chronic Conditions, Nutrition, Evidence-Based Practice, Guidelines
Andrews AL, Brinton DL, Simpson AN
A comparison of administrative claims-based risk predictors for pediatric asthma.
This retrospective cohort study used 2013-2014 MarketScan Medicaid data to compare administrative claims-based risk predictors of emergency department (ED) visits for pediatric asthma. The cohort included were children aged 2 to 17 years. Seven risk predictors were compared for 3-month subsequent ED visits/hospitalizations: 3-month rolling asthma medication ratio (AMR), Healthcare Effectiveness Data and Information Set (HEDIS) criteria, revised HEDIS criteria, quarterly short-acting β-agonist (SABA) claims, prior ED visit, prior hospitalization, and prior ED visit or hospitalization. Sensitivity, specificity, positive and negative predictive value (PPV and NPV), and percentage of population identified as high risk were compared for each risk predictor utilization the McNemar test. Cohort total population was 214,452 children with a mean age of 7.8 years. HEDIS and revised HEDIS identified prohibitively large cohorts as high-risk (67% and 48%). For the remaining measures, the NPV range was 97% to 99%, indicating high performance at identifying patients who would not benefit from intervention using AMR and SABA count. Superior sensitivities were found for ED visit and ED/hospitalization measures compared with pharmacy claims-based measures.
AHRQ-funded; HS026783.
Citation: Andrews AL, Brinton DL, Simpson AN .
A comparison of administrative claims-based risk predictors for pediatric asthma.
Am J Manag Care 2021 Dec;27(12):533-37. doi: 10.37765/ajmc.2021.88792..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Risk
Hirayama A, Goto T, Faridi MK
Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013.
The authors sought to investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation using data from State Inpatient Databases from seven U.S. states. They found that, overall, OSA was associated with a significantly higher incident rate of all-cause readmission. Additionally, OSA was associated with higher incident rates of readmissions for five major diseases: asthma, COPD, respiratory failure, pneumonia, and congestive heart failure, compared to non-OSA.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013.
J Asthma 2021 Sep;58(9):1176-85. doi: 10.1080/02770903.2020.1781887..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sleep Problems, Hospital Readmissions, Asthma, Respiratory Conditions, Chronic Conditions
Curry CW, Felt D, Kan K
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
Researchers sought to examine adjusted odds of non-remitting asthma by sexual identity, race/ethnicity, and their intersections, along with their relationship with traditional non-remitting asthma risk factors and victimization. Using data from the Youth Risk Behavior Survey, they found that, at the intersections, 8 sexual minority and racial/ethnic minority subpopulations were significantly more likely to have non-remitting asthma compared with White heterosexual sex-matched peers. They concluded that the evidence suggests that traditional non-remitting asthma risk factors and victimization may partly explain disparities in non-remitting asthma.
AHRQ-funded; HS026385.
Citation: Curry CW, Felt D, Kan K .
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
J Allergy Clin Immunol Pract 2021 Sep;9(9):3396-406. doi: 10.1016/j.jaip.2021.04.046..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Disparities
Joseph CLM, Alexander GL, Lu M
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
The authors piloted an electronic medical record-based tailored discussion guide (TDG) and a brief provider training to address weight management in overweight teens with asthma. They observed modest improvements in patient-reported asthma outcomes and health behaviors. They found strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. They recommended addressing challenges to recruitment and clinic adaptation prior to advancing to a full-scale trial.
AHRQ-funded; HS022417.
Citation: Joseph CLM, Alexander GL, Lu M .
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
Pilot Feasibility Stud 2021 Aug 30;7(1):167. doi: 10.1186/s40814-021-00848-6..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Asthma, Chronic Conditions, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Piwnica-Worms K, Staiger B, Ross JS
Effects of forced disruption in Medicaid managed care on children with asthma.
The objective of this study was to evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma. The investigators concluded that while there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.
AHRQ-funded; HS022882; HS025164.
Citation: Piwnica-Worms K, Staiger B, Ross JS .
Effects of forced disruption in Medicaid managed care on children with asthma.
Health Serv Res 2021 Aug;56(4):668-76. doi: 10.1111/1475-6773.13643..
Keywords: Children/Adolescents, Medicaid, Asthma, Respiratory Conditions, Chronic Conditions, Quality of Care
Doshi H, Hsia B, Shahani J
Impact of technology-based interventions on patient-reported outcomes in asthma: a systematic review.
This systematic review’s goal was to identify which technology-based interventions (TBIs) for asthma management have been formally evaluated using patient-reported outcomes (PROs). The authors aimed to: 1) identify the TBIs that have been evaluated in clinical trials using PROs; 2) identify the most commonly used PROs in these trials; and 3) determine the impact of TBIs on PROs in the management of chronic asthma. PubMed and Clinicaltrials.gov databases were searched for English-language studies published between January 2000 and February 2020. The final analysis included 14 clinical trials with 1 to 3 arms. Five different TBI types were identified, most commonly involving multimedia education. Four different categories of PROs were identified. At least 1 PRO domain with positive outcomes were reported by patients in 12 of 14 studies.
AHRQ-funded; R18 HS025645.
Citation: Doshi H, Hsia B, Shahani J .
Impact of technology-based interventions on patient-reported outcomes in asthma: a systematic review.
J Allergy Clin Immunol Pract 2021 Jun;9(6):2336-41. doi: 10.1016/j.jaip.2021.01.027..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Telehealth, Health Information Technology (HIT)
Puebla Neira DA, Hsu ES, Kuo YF
Readmissions reduction program: mortality and readmissions for chronic obstructive pulmonary disease.
Implementation of the Hospital Readmissions Reduction Program (HRRP) following discharge of patients with chronic obstructive pulmonary disease (COPD) has led to a reduction in 30-day readmissions with unknown effects on postdischarge mortality. The objective of this retrospective cohort study was to examine the association of HRRP with 30-day hospital readmission and 30-day postdischarge mortality rate in patients after discharge from COPD hospitalization.
AHRQ-funded; HS020642.
Citation: Puebla Neira DA, Hsu ES, Kuo YF .
Readmissions reduction program: mortality and readmissions for chronic obstructive pulmonary disease.
Am J Respir Crit Care Med 2021 Feb 15;203(4):437-46. doi: 10.1164/rccm.202002-0310OC..
Keywords: Hospital Readmissions, Respiratory Conditions, Chronic Conditions, Mortality, Hospital Discharge, Hospitalization
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Beltran Ale G, Benscoter D, Hossain MM
Impact of respiratory viral polymerase chain reaction testing on de-escalation of antibiotic therapy in children who require chronic positive pressure ventilation.
This study examined whether positive viral infection results stops antibiotic use in children who require chronic positive pressure ventilation (CPPV) who are frequently hospitalized with acute respiratory infections. A retrospective cohort study was conducted with 118 children on CPPV who had respiratory viral polymerase chain reaction (RVP) testing on admission. A viral pathogen was identified in 46.5% of the cases, with rhinovirus the most frequently identified. Antibiotic de-escalation occurred in only 33% of admissions and did not seem to impact antibiotic prescribing for hospitalized children on CPPV.
AHRQ-funded; HS012538.
Citation: Beltran Ale G, Benscoter D, Hossain MM .
Impact of respiratory viral polymerase chain reaction testing on de-escalation of antibiotic therapy in children who require chronic positive pressure ventilation.
Pediatr Pulmonol 2020 Aug;55(8):2150-55. doi: 10.1002/ppul.24884..
Keywords: Children/Adolescents, Respiratory Conditions, Antibiotics, Medication, Chronic Conditions
Iyer AS, Goodrich CA, Dransfield MT
End-of-life spending and healthcare utilization among older adults with chronic obstructive pulmonary disease.
This study examined end-of-life spending and healthcare utilization among Medicare beneficiaries aged 65 years or older with chronic obstructive pulmonary disease (COPD) who died during the period 2013-2014. Data on 146,240 decedents with COPD was investigated from 306 hospital referral regions (HRRs). The overall spending during the last 2 years of life varied significantly nationwide. Inpatient care accounted for 40.2% of spending, with 82% of decedents admitted to the hospital for 13.7±3.1 days and 55%±11% admitted to an intensive care unit for 3-7 days. Skilled nursing facilities accounted for 11.6% of spending and were utilized by 31-45% of decedents for 14-23 days. Hospitals were utilized by 39-56% of decedents and accounted for 10.3% of spending.
AHRQ-funded; HS023009.
Citation: Iyer AS, Goodrich CA, Dransfield MT .
End-of-life spending and healthcare utilization among older adults with chronic obstructive pulmonary disease.
Am J Med 2020 Jul;133(7):817-24.e1. doi: 10.1016/j.amjmed.2019.11.024..
Keywords: Elderly, Healthcare Utilization, Respiratory Conditions, Chronic Conditions, Healthcare Costs, Palliative Care
Kwah JH, Somani SN, Stevens WW
Clinical factors associated with acute exacerbations of chronic rhinosinusitis.
The objective of this retrospective cohort study was to identify clinical factors associated with frequent acute exacerbation of chronic rhinosinusitis (AECRS). Findings showed that patients with frequent episodes of AECRS were characterized by a higher prevalence of asthma, allergic rhinitis, eosinophil count of at least 150 cells per microliter, autoimmune disease, and other allergic and immunologic diseases. These findings identified a high-risk phenotype of patients with chronic rhinosinusitis for preventive interventions to reduce exacerbation frequency.
AHRQ-funded; HS023011.
Citation: Kwah JH, Somani SN, Stevens WW .
Clinical factors associated with acute exacerbations of chronic rhinosinusitis.
J Allergy Clin Immunol 2020 Jun;145(6):1598-605. doi: 10.1016/j.jaci.2020.01.023..
Keywords: Respiratory Conditions, Chronic Conditions
Singh M, Duarte AG, Hsu ES
Trends and factors associated with nebulized therapy prescription in older adults with chronic obstructive pulmonary disease from 2008 to 2015.
Medical management of patients with chronic obstructive pulmonary disease (COPD) includes nebulized therapy as an option for inhalational drug delivery. A broad variety of short- and long-acting bronchodilators and inhaled corticosteroids in the nebulized form are available. Despite this, limited information exists on the pattern and predictors of nebulized prescription. In this retrospective cross-sectional study, the investigators examined the trend and factors associated with prescription of nebulized therapy among Medicare beneficiaries with COPD.
AHRQ-funded; HS020642.
Citation: Singh M, Duarte AG, Hsu ES .
Trends and factors associated with nebulized therapy prescription in older adults with chronic obstructive pulmonary disease from 2008 to 2015.
J Aerosol Med Pulm Drug Deliv 2020 Jun;33(3):161-69. doi: 10.1089/jamp.2019.1582..
Keywords: Elderly, Respiratory Conditions, Chronic Conditions, Medication
Goto T, Yoshida K, Faridi MK
Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation.
This study examined whether adding social factors improved the predictive ability for 30-day hospital readmissions for COPD. Social factors include educational level and marital status. Out of 905 hospitalizations identified in the Medicare Current Beneficiary Survey from 2006 through 2012, 18.5% were readmitted within 30 days. The optimized model including social factors for prediction improved for early readmissions but not for late readmissions.
AHRQ-funded; HS023305.
Citation: Goto T, Yoshida K, Faridi MK .
Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation.
BMC Pulm Med 2020 Apr 29;20(1):107. doi: 10.1186/s12890-020-1136-8..
Keywords: Respiratory Conditions, Hospital Readmissions, Hospitalization, Social Determinants of Health, Chronic Conditions
Donovan BM, Abreo A, Ding T
Dose, timing, and type of infant antibiotic use and the risk of childhood asthma.
This study examined the association between dose, timing and type of infant antibiotic use and the risk of childhood asthma. The study examined a cohort of 152,622 children enrolled in the Tennessee Medicaid Program. At least 79% had at least one antibiotic prescription fill during infancy. There was a 20% increase in odds of childhood asthma for each additional antibiotic filled. There was no significant association between timing, formulation, anaerobic coverage and class of antibiotics and childhood asthma. However, broad spectrum antibiotic fills increased the odds of development of childhood asthma compared to narrow spectrum only fills.
AHRQ-funded; HS018454.
Citation: Donovan BM, Abreo A, Ding T .
Dose, timing, and type of infant antibiotic use and the risk of childhood asthma.
Clin Infect Dis 2020 Apr 10;70(8):1658-65. doi: 10.1093/cid/ciz448..
Keywords: Newborns/Infants, Children/Adolescents, Antibiotics, Medication, Asthma, Respiratory Conditions, Risk, Chronic Conditions